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What are individuals jt ROM affected by?
- genetic makeup
- age of patient
- presence/absence of any disease process=may increase or decrease ROM
- amt and type of physical activity
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What is an abnormal condition in which theres a shortening and tightening of a set of muscles, tendons, or ligaments and a stretching of the opposite muscle groups?
contracture
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What is flaccid?
lack of voluntary motion and muscle tone. decrease in muscle tone
stroke patients initially
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What three conditions are part of the upper motor neurons, which affects CNS?
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What is sustained involuntary muscle contractions with abnormal and increased muscle tone?
spasticity
-can work with this a little to loosen it up
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What is a clonus?
rapid, alternating contraction and relaxation of muscles with CNS damage typically triggered by a quick stretch. rapid bouncing
-kinda of like a tremor
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What is a constant, involuntary resistance to mvmt with hypertonicity?
rigidity
- -parkinsons patients
- -very stiff
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What are the 2 types of rigidity?
lead pipe- struggle, never moves (empire state)
cog wheel- jerks, it will let go just a little
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What is a muscle contraction in response to injury?
spasm
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What is a bony union that forms when a contracture has maintained a joint in stable position for a long period of time?
ankylosis
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What is hypotonicity?
decreased muscle tone
down syndrome
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What is hypertonicity?
increased muscle tone
stroke (initially after onset)
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What is full range?
when a muscle contracts to the limit of its normal capacity from a position of full stretch
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What is outer range?
from full stretch to mid-point of full range
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What is inner range?
from mid point to full contraction
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What is middle range?
any distance betwen the middle of the outer range and the middle of the inner range
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In general, what are the methods of controlling progression of a program?
- 1. easiest -> hardest
- 2. isometric -> isotonic -> isokinetic
- 3. large muscle groups ->smaller groups
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Specifically, what are 7 ways we can controll the progression of a program?
- 1. change length of rest period
- 2. increase number of sets/bouts
- 3. increase repetitions
- 4. increase weight/intensity
- 5. change speed
- 6. change starting postition
- 7. combine exercises (when a pt is acute, normally only work with one plane..as they progress we combine exercises and planes)
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What are some precautions to be aware of with exercise programs?
- protect the ind. from undue strain
- be sure pt is maintaining fair breathing (watch for valsalva maneuver)
- be aware of differences in firm/soft surfaces
- make sure exercise isnt too strenuous, adjust accordingly
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What are 2 indications of too much ROM or wrong motion?
- increased pain
- increased inflammation
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What are some things position selection is based on?
- presence of pain or discomfort
- ability to assume the position desired
- use a short lever arm vs a long lever arm
- need to stabilize body parts
- use of gravity for assistance or resistance
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What is the valsalva maneuver?
exhalation against a closed glottis
- decreased blood flow to heart, cardiac output, arterial BP
- alter heart rate
- increase stress on CV system, intra-abdominal pressure
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What are some indications for PROM?
- semicomatose/comatose
- elderly pts with limited mobility/mentation
- pts on complete bed rest
- paralyzed pts
- when active motion is contraindicated (some cardiacs, postsurgical, actue inflam/pain)
- when active motion produces unwanted muscle tone
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What is the goal of PROM?
maintain existing jt and soft tissue mobility to prevention of contractures
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What are some limitations for PROM?
- difficult to get conscious pt to relax
- will not: prevent atrophy, increase strength or endurance
- will not assist circulation
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What is an indication for AAROM?
weak musculature (whenever a pt can actively contract muscles but needs some assistance to complete or initiate range)
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What is the goal of AAROM?
maintain physiologic elasticity an contractility of muscles and gradually increase strength and ROM
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When are both PROM and AAROM both contraindicated?
under any circumstance where mvmt of a part would disrupt healing
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What are some examples of possible disruptive healing contraindications?
- imm. following ligament, muscle, tendon, or joint tear or surgical repair (some are allowed)
- unhealed fractures
- unstable CV pts (s/p MI, angina)
- pulmonary emboli untreated (like DVT)
- blood clot (DVT)
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What are some effects of PROM?
- assist circulation
- decreased jt contracture
- maintains jt and soft tissue integrity
- decreases pain
- enhance synovial movement
- assist in healing
- awareness of mvmt
- maintain elasticity
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What are some affects of AROM and AAROM?
- all those of PROM plus:
- increase circulation and prevent thrombus formation
- maintain physiologic elasticity and contractility
- provide sensory feedback from the contracting muscle
- provide a stimulus for bone and jt tissue integrity
- develop coordination and motor skills for functional activities
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What are affects of RROM?
everything for PROM/AROM/AAROM
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What type of ROM is used to strengthen is pt is weak?
AAROM
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What type or ROM is used to help improve CV with an aerobic program?
AAROM/AROM
if done with mulitple reps and results are monitored
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What will AROM not do?
- maintain or improve strength in strong muscles
- will only develop skill or coordination in patterns used
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With what type of insufficiency does the muscle shorten and contract to the fullest extent (will go no further)?
active insufficiency
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With what type of insufficiency are the muscles fully elongated over 2 joints and wont stretch anymore?
passive insufficiency
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What is CPM?
continuous passive motion
- -motion uninterrupted for extended periods of time
- -usually mechanical
- -all passive-no muscle fatigue
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Who introduced the concept of CPM?
dr. robert salter
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What are some benefits of CPM?
- may reduce adhesions/contracture formation
- decrease pain and edema
- enahnce nutrition to a joint
- increase synovial fluid lubrication
- promote wound healing
- counteracts ill effects of immobilization
- maintain/increase PROM
- restore gliding
- reduce jt stiffness
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What are some contraindications of CPM?
- active infection
- tendon quality
- fracture status
- tendon nutrition
- vascular status
- sensibility
- pt makeup
- gadget tolerance
- intelligence
- social/financial support
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